Ryan Keith Harris, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2021016226 Issued in MO

Practice address

121 N Main Ave
Bolivar, MO 65613-1517

Phone

(417) 422-4540

NPI assigned

Oct 2, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650499200000",
    "number": "1740617992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 N MAIN AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656131517",
            "telephone_number": "417-422-4540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 N MAIN AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656131517",
            "telephone_number": "417-422-4540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "RYAN",
        "middle_name": "KEITH",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-10-02",
        "last_updated": "2022-04-21",
        "certification_date": "2022-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-4515",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2021016226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ryan@bluecedardentistry.com",
            "affiliation": "N",
            "address_1": "121 N Main Ave",
            "city": "Bolivar",
            "state": "MO",
            "country_code": "US",
            "postal_code": "656131517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Herbert Jones Haman, DPT
• Mackenzie Hankins, M.S. CCC-SLP
• Mallory Ruth Harper
• Louis B Harris, M.D.
• Penelope Jane Harris, MD
• Tony Harris, LAT
• Alex Harrison, ATC
• Heather Nicole Harrison, EDUCATION BACHELORS
• Angel Haun, MAADC
• Shannon M. Hauschildt, PA-C

• All providers in Bolivar, MO
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.